護理師正準備為心衰竭病人靜脈注射毛地黃（Digoxin），若發現何種評估結果需暫停給藥？
A nurse is administering a dose of intravenous digoxin to a client with heart failure. Which assessment finding requires the nurse to withhold the medication?
- ABlood pressure of 110/70 mmHg血壓 110/70 mmHg
- BSerum potassium level of 4.2 mEq/L血清鉀濃度 4.2 mEq/L
- CRespiratory rate of 18 breaths/min呼吸頻率 18 次/分
- DApical heart rate of 54 beats/min✓ 正解心尖脈搏 54 次/分
毛地黃（Digoxin）具有強心作用（增加心肌收縮力）及負性變時作用（減慢房室結傳導速度）。給藥前必須評估心跳速率，若心跳過慢（成人 < 60 bpm），給藥可能導致嚴重的竇性心搏過緩（Sinus Bradycardia）或致命的房室傳導阻滯（AV Block）。臨床護理評估時，應執行完整一分鐘的「心尖脈（Apical Pulse）」測量，而非僅測量橈動脈，以確保數據準確性。
Digoxin has both a positive inotropic effect (increasing myocardial contractility) and a negative chronotropic effect (slowing conduction through the AV node). Before administration, the heart rate must be assessed; if the rate is too slow (under 60 bpm in adults), giving the drug may produce severe sinus bradycardia or potentially fatal AV block. Clinically, the apical pulse should be counted for a full minute rather than relying on the radial pulse, to ensure accuracy.
在美國臨床執業中，針對毛地黃給藥的規範非常明確，標準護理常規通常直接規定心尖脈 < 60 bpm 即須停藥並通知醫師。台灣臨床環境有時會依據醫師個別醫囑調整（例如 50 或 55 bpm），但在 NCLEX 考試中，請務必遵循 60 bpm 為標準安全界線。